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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date I Ill-sl IZ_ OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE 1 )� <br /> Pacific Gas and Electric Co. VALID a 0 DRIVEWAYS: <br /> STREET <br /> P.O. Box 930 AREA �✓/�D11! QUAD <br /> Stockton, CA 95201 TYPE vt�S <br /> FORMS <br /> NOTES <br /> :37 `I2— i <br /> (Area Code-Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> Traffic Control Plan <br /> See attached sketch. Shall be as per <br /> PM 3 D g y � Z i y current M.U.T.C.D. <br /> Notif. kD(PZ.D375( California supplement. <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the IJ side of l.t V 5T TL I�d10 2b approximately IZ"X/o- to�-wV� � <br /> of. L I V IZ �� (9t/mile <br /> by performing the following work(description of work): <br /> EK c�a �� e �Z) y�x y- -�-e// f��/mss (l) /A) Di�zT L[[ iA) <br /> a /2421.tdn� F x 1:-!;71;1l(rr Fe <br /> Work will commence on or about I I 3 D /z for approximately / 5r days. <br /> I,the undersigned,certify that I am the owner of the respective property,or am qualified to represent the owner and agree to do the <br /> work described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval.. <br /> Signature of plicant-Title Date <br /> EAPUB-SVNKIMASTERPSIENCROACHMENT PERMIT APPLICATION.DOC (01/08) <br />